Guest guest Posted December 6, 2004 Report Share Posted December 6, 2004 Hello. This is my first time to post. I have 10 month old twin daughters that have been to Cranial Tech and they said both are candidates for the band. My wife sent me an email today with some bad news though. I just wanted to see if anyone had any ideas or a direction to point us. We won't be able to get the bands without help from insurance. Here's the email from my wife: from Cranial tech just called. She said my insurance denied because it is an experimental procedure. She said that she will send appeal papers, but with Blue Cross, once they deny something, they usually don't change their mind. She said they have a payment plan of 600.00 per month per child. She suggested we get on the internet. Said there are places that help with contributions. Also said we may want to contact our State Representative. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2004 Report Share Posted December 6, 2004 Hello, I would definetly appeal. The DOC Band is FDA approved so it cannot be considered an experimental procedure. Info on their FDA approval is at their site. www.cranialtech.com Along with the info on this board, you may also want to check out the insurance help section on the cappskids site http://www.cappskids.org/PlagioInsuranceHelp.htm they have info on the investigational/experimental denial and some sample appeal letters. I know BCBS in certain states gives parents a hard time getting the band covered, but other states cover it. So if you get a chance post the state your BCBS is in. Maybe someone who has your insurance can give you some more info. Good Luck! in NJ mom to Jake 2yrs(doc band grad 2003) and Tyler 5yrs. --- In Plagiocephaly , " colejo74 " <colejo74@y...> wrote: > > Hello. This is my first time to post. I have 10 month old twin > daughters that have been to Cranial Tech and they said both are > candidates for the band. My wife sent me an email today with some > bad news though. I just wanted to see if anyone had any ideas or a > direction to point us. We won't be able to get the bands without > help from insurance. > Here's the email from my wife: > > from Cranial tech just called. She said my insurance denied > because it is an experimental procedure. She said that she will send > appeal papers, but with Blue Cross, once they deny something, they > usually don't change their mind. She said they have a payment plan > of 600.00 per month per child. She suggested we get on the > internet. Said there are places that help with contributions. Also > said we may want to contact our State Representative. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 6, 2004 Report Share Posted December 6, 2004 I guess I didn't mention that this is BCBS Health select in Texas. I've seen a few other people mention having BCBS health select in Texas and it doesn't look good. --- In Plagiocephaly , " colejo74 " <colejo74@y...> wrote: > > Hello. This is my first time to post. I have 10 month old twin > daughters that have been to Cranial Tech and they said both are > candidates for the band. My wife sent me an email today with some > bad news though. I just wanted to see if anyone had any ideas or a > direction to point us. We won't be able to get the bands without > help from insurance. > Here's the email from my wife: > > from Cranial tech just called. She said my insurance denied > because it is an experimental procedure. She said that she will send > appeal papers, but with Blue Cross, once they deny something, they > usually don't change their mind. She said they have a payment plan > of 600.00 per month per child. She suggested we get on the > internet. Said there are places that help with contributions. Also > said we may want to contact our State Representative. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2004 Report Share Posted December 7, 2004 Hello and welcome to the group. I'm sorry your insurance denied the bands. I know we currently have a member that is taken BC/BS to court a few times, and it still isn't approved from what I've heard last. Don't give up though. Appeal as long as you can. Sandy Willow's Mom torticollis resolved Cranio Germany Grad --- In Plagiocephaly , " colejo74 " <colejo74@y...> wrote: > > Hello. This is my first time to post. I have 10 month old twin > daughters that have been to Cranial Tech and they said both are > candidates for the band. My wife sent me an email today with some > bad news though. I just wanted to see if anyone had any ideas or a > direction to point us. We won't be able to get the bands without > help from insurance. > Here's the email from my wife: > > from Cranial tech just called. She said my insurance denied > because it is an experimental procedure. She said that she will send > appeal papers, but with Blue Cross, once they deny something, they > usually don't change their mind. She said they have a payment plan > of 600.00 per month per child. She suggested we get on the > internet. Said there are places that help with contributions. Also > said we may want to contact our State Representative. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2004 Report Share Posted December 7, 2004 I'm sorry to hear this. It is NOT experimental so that should be an easy reason to dispute. I hope that they then don't change their reason to something else! You can win; many others have including myself (although different ins. co.) Please do not let past members experiences discourage you. I too would make a claim to your State's ins. Dept. There may be an on-line claim on the net. It's free. Check out our ins. help files and if there is anything you cannot find here just let us know. Good luck. You CAN DO IT! Sue Colin F., 14 mos. STARband grad --- In Plagiocephaly , " colejo74 " <colejo74@y...> wrote: > > Hello. This is my first time to post. I have 10 month old twin > daughters that have been to Cranial Tech and they said both are > candidates for the band. My wife sent me an email today with some > bad news though. I just wanted to see if anyone had any ideas or a > direction to point us. We won't be able to get the bands without > help from insurance. > Here's the email from my wife: > > from Cranial tech just called. She said my insurance denied > because it is an experimental procedure. She said that she will send > appeal papers, but with Blue Cross, once they deny something, they > usually don't change their mind. She said they have a payment plan > of 600.00 per month per child. She suggested we get on the > internet. Said there are places that help with contributions. Also > said we may want to contact our State Representative. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2004 Report Share Posted December 7, 2004 Hi, i also have BCBS (Capital Care, HMO) and we were denied. I've already sent in my appeal (which was sent to the wrong person and they filed it as a claim, not an appeal, AHHHH!!) but our denial was based on it being cosmetic and not medically necessary. There's great info on the web to help with an appeal. We went ahead and are paying out of pocket until we hear again from insurance. (Thanks to gma & gpa's help). Don't give up on an appeal. In mine i cc'd the governor, state rep's, and my states insurance comissioner. Good luck and let us know what you decide to do. Plus CT has been approved by the gov't for this treatment for years, this is not experimental! Ashburn, VA >From: " colejo74 " <colejo74@...> >Reply-Plagiocephaly >Plagiocephaly >Subject: Insurance Denied >Date: Mon, 06 Dec 2004 22:42:02 -0000 > > >Hello. This is my first time to post. I have 10 month old twin >daughters that have been to Cranial Tech and they said both are >candidates for the band. My wife sent me an email today with some >bad news though. I just wanted to see if anyone had any ideas or a >direction to point us. We won't be able to get the bands without >help from insurance. >Here's the email from my wife: > > from Cranial tech just called. She said my insurance denied >because it is an experimental procedure. She said that she will send >appeal papers, but with Blue Cross, once they deny something, they >usually don't change their mind. She said they have a payment plan >of 600.00 per month per child. She suggested we get on the >internet. Said there are places that help with contributions. Also >said we may want to contact our State Representative. > > > > > _________________________________________________________________ Is your PC infected? Get a FREE online computer virus scan from McAfee® Security. http://clinic.mcafee.com/clinic/ibuy/campaign.asp?cid=3963 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2004 Report Share Posted December 7, 2004 from what the guy at the bureau of insurance told me was that of all denials 50% of appeals go through, appeal again, 50% of those go through, denied again, 50% of those then go through, etc... Most people give up because it's so stressful and exausting trying to get an appeal together. But don't give up. Fight till they pay! That's what i'm going to do. Ashburn, VA >From: " colejo74 " <colejo74@...> >Reply-Plagiocephaly >Plagiocephaly >Subject: Re: Insurance Denied >Date: Mon, 06 Dec 2004 22:46:43 -0000 > > >Here is an update from my wife: >Well I contacted our State Representative. The lady that I spoke >with said to file the appeal process. But looks like if it is >denied, then there is nothing I can do. I can't file through the >Department of Insurance, because I am a state employee. She is going >to double check some information and get back with me. > >--- In Plagiocephaly , " colejo74 " <colejo74@y...> >wrote: > > > > Hello. This is my first time to post. I have 10 month old twin > > daughters that have been to Cranial Tech and they said both are > > candidates for the band. My wife sent me an email today with some > > bad news though. I just wanted to see if anyone had any ideas or a > > direction to point us. We won't be able to get the bands without > > help from insurance. > > Here's the email from my wife: > > > > from Cranial tech just called. She said my insurance denied > > because it is an experimental procedure. She said that she will >send > > appeal papers, but with Blue Cross, once they deny something, they > > usually don't change their mind. She said they have a payment plan > > of 600.00 per month per child. She suggested we get on the > > internet. Said there are places that help with contributions. >Also > > said we may want to contact our State Representative. > > > _________________________________________________________________ Express yourself instantly with MSN Messenger! Download today - it's FREE! http://messenger.msn.click-url.com/go/onm00200471ave/direct/01/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2004 Report Share Posted December 7, 2004 You are in luck. This is a straight forward one to fight. It is not and has not been since 1998 (is that the right year??) an experimental procedure. The DOC band specifically has been FDA approved since 1998 to treat plagio. We have a ton of info in the links and files sections. Just look for the insruance help folders. There are also sample appeal letters that address this very issue. Good luck. mom to na DOC Grad 2/04 Tort Resolved South Carolina www.thefilyaws.com colejo74 <colejo74@...> wrote: Hello. This is my first time to post. I have 10 month old twin daughters that have been to Cranial Tech and they said both are candidates for the band. My wife sent me an email today with some bad news though. I just wanted to see if anyone had any ideas or a direction to point us. We won't be able to get the bands without help from insurance.Here's the email from my wife: from Cranial tech just called. She said my insurance denied because it is an experimental procedure. She said that she will send appeal papers, but with Blue Cross, once they deny something, they usually don't change their mind. She said they have a payment plan of 600.00 per month per child. She suggested we get on the internet. Said there are places that help with contributions. Also said we may want to contact our State Representative. For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2004 Report Share Posted December 7, 2004 And how many time can we appeal? There is not a limit of appeals? Ivonne Mom to laura gill <mamagill@...> wrote: from what the guy at the bureau of insurance told me was that of all denials 50% of appeals go through, appeal again, 50% of those go through, denied again, 50% of those then go through, etc... Most people give up because it's so stressful and exausting trying to get an appeal together. But don't give up. Fight till they pay! That's what i'm going to do.Ashburn, VA>From: "colejo74" <colejo74@...>>Reply-Plagiocephaly >Plagiocephaly >Subject: Re: Insurance Denied>Date: Mon, 06 Dec 2004 22:46:43 -0000>>>Here is an update from my wife:>Well I contacted our State Representative. The lady that I spoke>with said to file the appeal process. But looks like if it is>denied, then there is nothing I can do. I can't file through the>Department of Insurance, because I am a state employee. She is going>to double check some information and get back with me.>>--- In Plagiocephaly , "colejo74" <colejo74@y...>>wrote:> >> > Hello. This is my first time to post. I have 10 month old twin> > daughters that have been to Cranial Tech and they said both are> > candidates for the band. My wife sent me an email today with some> > bad news though. I just wanted to see if anyone had any ideas or a> > direction to point us. We won't be able to get the bands without> > help from insurance.> > Here's the email from my wife:> >> > from Cranial tech just called. She said my insurance denied> > because it is an experimental procedure. She said that she will>send> > appeal papers, but with Blue Cross, once they deny something, they> > usually don't change their mind. She said they have a payment plan> > of 600.00 per month per child. She suggested we get on the> > internet. Said there are places that help with contributions.>Also> > said we may want to contact our State Representative.>>>_________________________________________________________________Express yourself instantly with MSN Messenger! Download today - it's FREE! http://messenger.msn.click-url.com/go/onm00200471ave/direct/01/For more plagio info Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 7, 2004 Report Share Posted December 7, 2004 i think each state or each insurance company may be different. I'm not positive on that one. I do know that each insurance company has their own amt. of time an appeal has to be to their office. Mine was 6 months but i know others have shorter time than that. >From: Ivonne Chandler <ivomalone@...> >Reply-Plagiocephaly >Plagiocephaly >Subject: RE: Re: Insurance Denied >Date: Tue, 7 Dec 2004 12:35:59 -0800 (PST) > >And how many time can we appeal? There is not a limit of appeals? > >Ivonne >Mom to > >laura gill <mamagill@...> wrote: >from what the guy at the bureau of insurance told me was that of all >denials >50% of appeals go through, appeal again, 50% of those go through, denied >again, 50% of those then go through, etc... Most people give up because >it's so stressful and exausting trying to get an appeal together. But >don't >give up. Fight till they pay! That's what i'm going to do. > > >Ashburn, VA > > >From: " colejo74 " <colejo74@...> > >Reply-Plagiocephaly > >Plagiocephaly > >Subject: Re: Insurance Denied > >Date: Mon, 06 Dec 2004 22:46:43 -0000 > > > > > >Here is an update from my wife: > >Well I contacted our State Representative. The lady that I spoke > >with said to file the appeal process. But looks like if it is > >denied, then there is nothing I can do. I can't file through the > >Department of Insurance, because I am a state employee. She is going > >to double check some information and get back with me. > > > >--- In Plagiocephaly , " colejo74 " <colejo74@y...> > >wrote: > > > > > > Hello. This is my first time to post. I have 10 month old twin > > > daughters that have been to Cranial Tech and they said both are > > > candidates for the band. My wife sent me an email today with some > > > bad news though. I just wanted to see if anyone had any ideas or a > > > direction to point us. We won't be able to get the bands without > > > help from insurance. > > > Here's the email from my wife: > > > > > > from Cranial tech just called. She said my insurance denied > > > because it is an experimental procedure. She said that she will > >send > > > appeal papers, but with Blue Cross, once they deny something, they > > > usually don't change their mind. She said they have a payment plan > > > of 600.00 per month per child. She suggested we get on the > > > internet. Said there are places that help with contributions. > >Also > > > said we may want to contact our State Representative. > > > > > > > >_________________________________________________________________ >Express yourself instantly with MSN Messenger! Download today - it's FREE! >http://messenger.msn.click-url.com/go/onm00200471ave/direct/01/ > > > >For more plagio info Quote Link to comment Share on other sites More sharing options...
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